Telemedicine Buprenorphine Access For Incarcerated People: Lessons Learned From Maryland's Rural Jails

The promise of telemedicine to expand access to buprenorphine for opioid use disorder (OUD) within carceral settings is substantial, offering a lifeline to a population disproportionately affected by the opioid crisis. Our experience launching and managing a telemedicine-based buprenorphine treatment program in Maryland jails, however, has been a stark reminder of an adage in correctional health: "If you've worked in one jail, you've only worked in one jail." Each correctional facility presents a unique constellation of operational, cultural, and logistical challenges that shape the implementation and success of any new initiative, particularly one as sensitive as medications for OUD (MOUD). In this Commentary, we outline several critical hurdles we have encountered, as well as lessons learned from them, which we believe warrant careful consideration for others venturing into this vital work.